BMA Cymru Wales manifesto for a healthier Wales
June 2006
Improve access
Doctors share the aim of improving access to primary care and hospital services in Wales. Patients want to be seen quickly but not at the expense of good quality care. There is a danger that the setting of unrealistic targets can have an adverse effect on the quality of services. Waiting list initiatives have distorted treatment priorities in the past resulting in patients with less serious complaints being treated before those with more complex medical problems. Clinical need must dictate priority for treatment. Demand for both primary and secondary care services is increasing and improving access will require an increase in capacity within the NHS allied to new ways of working.
The BMA calls on all Welsh political parties to:
Establish relevant and achievable targets for access to the primary care team
Primary care is under pressure. The number of patient consultations has been rising dramatically at a time when GP numbers have shown just a small increase. Tasks that were once carried out in hospital are now the responsibility of the primary care team. BMA Cymru Wales believes that setting targets for access to primary care is unnecessary and will have an adverse impact on already over-stretched services. Not all patients need to be seen within 24 hours. There is a clear need to increase the number of GPs and other primary care workers. In the meantime, achieving artificial targets is likely to lead to a reduction in the time patients spend with their doctors, the loss of same day access and the introduction of inflexible appointment systems.
Improve access to secondary care services
There is understandable concern at the length of time patients have to wait in Wales for their first outpatient hospital appointment. Again this is a symptom of a service under pressure. More hospital doctors are needed if more patients are to be seen more quickly. Waiting for an outpatient appointment is a worrying and frustrating time for patients and puts extra demands on family doctors who have to provide ongoing support during this period. BMA Cymru Wales finds it unacceptable that primary care teams are being set a target of 24-hour access for their patients but a six to 12 months wait to access secondary care services is deemed appropriate by ministers. NHS managers must ensure that GPs can access diagnostic, outpatient and other specialist services quickly to ensure appropriate care for patients. Furthermore, the NHS should aim to improve efficiency by looking at innovative ways of working with GPs undertaking more clinical work.
Extend the role of other health professionals
Patients suffering from minor ailments are happy to be seen by a nurse or to be given advice by a pharmacist. The role of these and other professionals within the primary care team needs to be extended to give doctors more time to devote to the patients who need their skills. Although this is recognised by politicians as being an important development, it is still largely restricted to small pilot projects. NHS Wales needs to extend the role of other health professionals across the country, backed by resources to ensure the availability of sufficient numbers of suitably trained and supported staff.
Improve 24-hour care provision
Doctors have long provided 24-hour care for patients in emergencies. Rising demand has created extra pressures on doctors in accident and emergency units and on family doctors in parts of Wales which have not benefited from an adequate out-of-hours provision. Too many staff in Welsh hospitals are working in conditions that no longer meet the needs of modern emergency medicine. Increasing the availability of hospital beds is the single most important step to speed up the treatment of patients requiring emergency treatment.
Make better use of technology to provide health services
Telemedicine provides medical professionals in general practice and community hospitals with a vital link to specialist facilities in larger centres. Telemedicine links could also be used between accident and emergency centres and the ambulance service or nurse practitioner led services in remote areas.
Improve health services for prisoners
Prisoners are notoriously unhealthy and may have a multiplicity of problems including addiction and mental illness. Over 90 per cent come from deprived backgrounds. Equity of provision should apply to patients in prisons as much as it does elsewhere but the prison service has to be appropriately funded and guided to provide this service. Much of prison healthcare is provided by the private sector. When patients are released, there is a lack of coordination between the prison health service and the NHS for ongoing and future care. BMA Cymru Wales believes that effective coordination between the prison medical service and those caring for prisoners outside prison is essential.